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HB 6152

Insurance: health insurers; coverage for prescribed pediatric extended care; require. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406jj.

2023-2024 Regular Session Introduced by Jenn Hill and 8 co-sponsors

Bill Summary: HB 6152 - Insurance Coverage for Prescribed Pediatric Extended Care OverviewHouse Bill 6152 would require health insurance plans in Michigan to provide coverage for p

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Bill Summary · HB 6152

Bill Summary: HB 6152 - Insurance Coverage for Prescribed Pediatric Extended Care

Overview

House Bill 6152 would require health insurance plans in Michigan to provide coverage for prescribed pediatric extended care (PPEC) services for eligible children. PPEC centers provide comprehensive, medically necessary care and services to medically fragile or technology-dependent children who require more care than can be provided at home.

Key Provisions

  • Mandates that all health insurance plans operating in Michigan, including those offered through the individual, small group, and large group markets, must cover PPEC services for children who meet certain medical criteria.
  • Defines PPEC services as "skilled nursing, therapeutic, and related care provided in a nonresidential pediatric facility for a prescribed period of time each day."
  • Specifies that coverage must include all medically necessary PPEC services ordered by the child's physician or advanced practice registered nurse.
  • Prohibits health plans from imposing any annual or lifetime dollar limits, deductibles, copayments, coinsurance, or other cost-sharing requirements on PPEC coverage that are less favorable than those applied to primary care office visits.
  • Requires health plans to provide coverage for PPEC services to eligible children from birth to 21 years of age.

Potential Impact

  • This bill aims to improve access to comprehensive medical care and services for children with complex medical needs who require a higher level of care than can be provided at home.
  • By mandating insurance coverage, it could reduce the financial burden on families and increase utilization of PPEC centers, which may improve health outcomes for medically fragile children.
  • The requirement to cover PPEC services could result in increased costs for health insurance plans, which may be passed on to consumers through higher premiums.
  • Implementation of this bill may also require increased state oversight and regulation of PPEC centers to ensure quality of care and appropriate utilization.

Timeline

HB 6152 was introduced in the Michigan House of Representatives on January 22, 2025 and has been referred to the House Committee on Insurance for further consideration. If passed by the House and Senate, and signed into law by the governor, the new insurance coverage mandate would take effect on January 1, 2026.

Compiled from official sources — confirm details with the bill’s official record.

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